| NPI | 1225125222 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI JD088515) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 4301088515) |
| Enumeration Date | 2006-10-10 |
| Last Update Date | 2011-04-18 |